Effects of 5‐HT₃ receptor antagonists on cisplatin‐induced kidney injury

Nausea, vomiting, and renal injury are the common adverse effects associated with cisplatin. Cisplatin is excreted via the multidrug and toxin release (MATE) transporter, and the involvement of the MATE transporter in cisplatin‐induced kidney injury has been reported. The MATE transporter is also involved in the excretion of ondansetron, but the effects of 5‐HT₃ receptor antagonists used clinically for cisplatin‐induced renal injury have not been elucidated. Therefore, the aim of this study was to investigate the effects of 5‐HT₃ receptor antagonists in a mouse model of cisplatin‐induced kidney injury and to validate the results using medical big data analysis of more than 1.4 million reports and a survey of 3000 hospital medical records. The concomitant use of a first‐generation 5‐HT₃ receptor antagonist (ondansetron, granisetron, or ramosetron) significantly increased cisplatin accumulation in the kidneys and worsened renal damage. Conversely, the concomitant use of palonosetron had no effect on renal function compared with the use of cisplatin alone. Furthermore, an analysis of data from the US Food and Drug Administration Adverse Event Reporting System and retrospective medical records revealed that the combination treatment of cisplatin and a first‐generation 5‐HT₃ receptor antagonist significantly increased the number of reported renal adverse events compared with the combination treatment of cisplatin and a second‐generation 5‐HT₃ receptor antagonist. These results suggest that compared with the first‐generation antagonists, second‐generation 5‐HT₃ receptor antagonists do not worsen cisplatin‐induced acute kidney injury. The findings should be validated in a prospective controlled trial before implementation in clinical practice.

Study Highlights

• WHAT IS THE CURRENT KNOWLEDGE ON THE TOPIC?

The involvement of the multidrug and toxin release (MATE) transporter in cisplatin‐induced kidney injury has been reported. The MATE transporter is involved in the excretion of not only cisplatin but also ondansetron, a 5‐HT₃ receptor antagonist used as an antiemetic; however, the effects of 5‐HT₃ receptor antagonists used clinically for cisplatin‐induced renal injury have not been elucidated.

• WHAT QUESTION DID THIS STUDY ADDRESS?

The aim of this study was to investigate the effects of 5‐HT₃ receptor antagonists in a mouse model of cisplatin‐induced kidney injury and to validate the results using medical big data analysis of more than 1.4 million reports and a survey of 3000 hospital medical records.

• WHAT DOES THIS STUDY ADD TO OUR KNOWLEDGE?

The results suggest that compared with the first‐generation antagonists, second‐generation 5‐HT₃ receptor antagonists do not worsen cisplatin‐induced acute kidney injury.

• HOW MIGHT THIS CHANGE CLINICAL PHARMACOLOGY OR TRANSLATIONAL SCIENCE?

Promoting the use of second‐generation 5‐HT₃ receptor antagonists is expected to reduce the number of patients who develop cisplatin‐induced renal damage.